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Contemplating a Lab Renovation

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As clinical laboratories face a shortage of workers and rapidly changing diagnostic technology, many are considering renovating or redesigning their space to improve workflow, reduce turnaround time, and increase efficiency. In some cases, labs have simply outgrown their existing footprints or have layouts that no longer work for modern operations.

Englewood Hospital and Medical Center in Englewood, New Jersey, found itself in such a position in 2011. “The lab we had was built in the 1970s,” explained Janet Rosenberg, MT(ASCP), MBA, director of administrative laboratory services. “The layout did not lend itself to the ideal workflow. Our central receiving area was not adjacent to the core lab sections, which meant specimens would come in and would have to be walked down a corridor. Everything was spread out.”

The hospital hired an architect who also happened to be a medical technologist to draw up blueprints for the new lab. Karen Mortland, RA, MT(ASCP), president of Chicora, Pennsylvania-based Mortland Planning & Design, met with supervisors of each lab section to determine current and future needs. The goal, says Rosenberg, was to improve function, enhance the employee experience, increase efficiency, and be adaptable to future growth.

Renovation of the 24,800-square-foot lab cost about $5.2 million, took 14 months, and progressed in five phases. Although the lab did not gain more overall square footage, it added about 2,000 feet of usable space through the redesign.

Now, instead of being fixed in place, all benches and work areas are height-adjustable and on wheels, so they can be moved easily to accommodate new instruments, as well as improve the flow of people and specimens. The core lab—consisting of specimen receiving and processing, phlebotomy, blood bank, hematology and chemistry—is in one large room, which improves communications. Slide storage is on racks that can be moved electronically, and the lab boasts a new conference room and learning center. Additional renovations were completed on the staff’s locker room and restrooms to enhance employee comfort and convenience.

Since the renovation was completed in 2013, the Englewood lab has been able to process more specimens in the same amount of space, leading it to start a lab outreach program in 2014. “We increased our volume by about 40 percent last year and decreased turnaround time,” said Rosenberg, noting that there is still capacity for even more testing.

Large-Scale Redesign

On a larger scale, Geisinger Medical Center’s Division of Laboratory Medicine recently completed construction of a new 110,000-square-foot laboratory that cost about $55 million. Previously, the lab was spread throughout the main medical center in Danville, Pennsylvania, taking up close to 70,000 square feet. “What we had was in little patches here and there,” said Conrad Schuerch, MD, chair of the Division of Laboratory Medicine. “The original hospital was built in 1915 and did not have the necessary infrastructure.”

Though plans for a new lab had been in the works for some time, it wasn’t until a few years ago that the idea gained traction and funding was approved for the new construction. The new building employs an open lab concept, is centrally located on campus, has patient access near the main entrance of the hospital, and has ground-level access for couriers. What’s more, the anatomic pathology lab is located adjacent to the operating rooms (ORs), giving surgeons convenient frozen section service by subspecialty pathologists. Construction on the new building is almost complete, and the new lab should be operational by September.

Although the Geisinger project was much larger than Englewood’s, the goals were largely the same: improve workflow and efficiency and allow for future growth. A new pneumatic tube system that uses “Smart Path” technology is expected to reduce turnaround time for delivering specimens to other parts of the lab and hospital. The tubes will also enable the lab to deliver blood directly to the ORs. New large refrigeration units will automatically send electronic notices to the medical center’s supply department when stocks of a certain item are low, which Schuerch also expects to improve efficiency and shorten turnaround time.

To allow for future expansion, the Geisinger lab is built with a raised floor that gives access to electrical and water lines below. “We built this lab to last a century,” said Schuerch. “We can change configuration whenever we need to. There is complete flexibility.”

Things to Consider

Labs typically decide to renovate due to lack of space, lack of efficiency, and lack of staff. In deciding which direction to take, leaders should start by asking themselves the 10 things they would most like to change about their labs, advises Mortland, who has been involved in more than 300 lab redesigns during the past 15 years. Common answers include inefficient layout, fixed casework, problems with temperature and humidity, and lack of windows or natural light.

Vicki David, a principal with Ironhorse Architects in Denver, begins a redesign project by gathering information on equipment and throughput, determining which spaces need to be isolated and which need to be adjacent, assessing mechanical and electrical systems, and analyzing workflow.

Both Mortland and David recommend that lab directors contemplating a renovation consider the following:

Workload. What is your existing capacity and what is your target capacity? For how many years do you anticipate the redesigned lab will be able to meet your needs before needing another renovation?

Workflow. How can you change your existing procedures to be more efficient? Can you improve the functionality of the lab? What are some ways to reduce the number of steps lab technicians need to take as they perform testing?

Ergonomics. How can you make working in the lab a more pleasant experience for staff? Do you need a new HVAC system, more stalls in the restrooms, adjustable benches, better lighting?

Among the trends in modern lab design and renovation: big, open spaces rather than small, separate rooms; flexible casework systems; skylights or light wells to bring in natural light; and recycled rubber flooring.

One of the biggest challenges in renovating a lab is keeping the lab operational during the construction process, noted Mortland. In these situations, the renovation is done in phases, with sections of the lab constructed in another location, which then opens a space to construct the next phase. “It’s a bit like hopscotch,” she said.

Increasing capacity without adding more square footage is another typical challenge. “In these cases, you just have to turn straw into gold,” jokes David. “It’s about using the space better.”

Staff who are resistant to change can present yet another problem. Mortland said she makes it a point to engage all lab personnel in the renovation process. “I try to make it fun for staff,” she explained. “I try to get people to think outside the box and to keep everyone involved. In the end, it needs to be a collaborative process.”

Though a new lab can be costly, it should pay for itself in increased capacity, reduced staffing, and the ability to expand into new types of testing as the need arises. Done right, a redesigned lab is likely to be a win-win for both the lab and the health system.